Scott Rothschild

Topeka ? Gov. Sam Brownback’s decision to reject a $31.5 million federal grant to start a health insurance exchange stirred up controversy and confusion on Monday.

Kansas Insurance Commissioner Sandy Praeger told legislators that the state is in danger of not meeting a crucial deadline in implementation of the exchange.

Under the federal Affordable Care Act, the exchanges are meant to provide online marketplaces where consumers can shop for health insurance and receive subsidies, if eligible.

But Praeger conceded that development of the exchanges and the entire federal health reform law could be altered by legal decisions or the outcome of next year’s presidential and U.S. Senate elections.

“At this point, we just have to look at what is on the books today,” she told the Special Committee on Financial Institutions and Insurance.

“Tomorrow this could all change,” said Rep. Brenda Landwehr, R-Wichita, who is a vocal critic of the health reform law.

Praeger said even though that’s true, “It’s still important to stay at the table and deal with the uncertainties, otherwise it will be done to us.”

The issue of establishing a state-based exchange in Kansas was dealt a blow in August when Brownback rejected a $31.5 million “early innovator” grant from the U.S. Department of Health and Human Services.

Brownback, who had earlier supported the grant, rejected it, saying there were too many strings attached to the federal funding. He said his administration would not move forward on implementing the ACA until the U.S. Supreme Court had ruled on whether the law, signed by President Barack Obama, was constitutional.

Praeger said it is possible the court could rule on the case as early as June.

The exchanges are supposed to be in effect by 2014, and Praeger said the state was in danger of not being able to meet that deadline unless the Legislature next year agreed to move forward.

She said the federal government will implement an exchange in Kansas if the state doesn’t. Kansas would lose some flexibility if the feds put in the exchange, she said.